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35 Cedar Street
Hyannis, MA

Phone: 508-778-6363

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Any HIGHLY CONFIDENTIAL information such as 1) psychotherapy notes 2) mental health and disability services 3) alcohol and drug abuse treatment 4) HIV testing-treatment 5) sexually transmitted diseases 6) genetic testing 7) child or elder abuse 8) domestic abuse of an adult with a disability 9) sexual assault, would necessitate your written authorization, before disclosure beyond that requires by law.

Please contact CCIM's office manager, if you feel your privacy rights have been violated.

Complaints about your privacy may also be filed in writing to the Director, Office for Civil Rights of the United States Dept of Health and Human Services. You may request additional restrictions on our use and disclosure, beyond that which is allowed by law. While we are NOT required to agree to a requested restriction, we will consider all written requests carefully and respond in a timely basis.

We will accommodate any written reasonable request for you to receive your PHI by another means of communications or at an alternate location.

You may revoke your authorization at any time in writing to this office.

You have a right to inspect and copy your health and billing information. Under limited circumstances, we may deny access to all or a portion of your records. Please make request in writing. We may charge you for records as allowed under Mass Law. You may also be charged postage costs.

You may request in writing, that we amend PHI in your record. We will comply unless we believe that the information in the record is accurate and complete, or the other circumstances apply. You have a right to request an accounting of certain disclosures of your PHI during the period prior to the date of your written request, provided the period does not exceed 6 years and does not precede April 14, 2003, which is the effective date of the privacy act. You have the right, upon request, to receive a copy of this notice. We may change the terms of this Notice at any time as long as it is consistent with our current privacy policies or state or federal law. If we change this notice, we will post the new notice in the waiting area of the office. You may receive a copy of the new notice at any time upon request.

Thank You!

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